Prevention Of Opioid Use Disorder Research Articles

Pennsylvania invests $2 million in OUD prevention

Last week the Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced the availability of $2 million in funding to implement community‐based prevention services throughout the state to prevent opioid use disorder (OUD). Funding for these grants is provided from the Mallinckrodt Opioid Settlement, which was the result of a multistate investigation spearheaded by then‐Attorney General Josh Shapiro that led to billions in settlement agreements with opioid manufacturers and distributors. Shapiro is now governor.

Developing a Framework to Infer Opioid Use Disorder Severity From Clinical Notes to Inform Natural Language Processing Methods: Characterization Study.

Information regarding opioid use disorder (OUD) status and severity is important for patient care. Clinical notes provide valuable information for detecting and characterizing problematic opioid use, necessitating development of natural language processing (NLP) tools, which in turn requires reliably labeled OUD-relevant text and understanding of documentation patterns. To inform automated NLP methods, we aimed to develop and evaluate an annotation schema for characterizing OUD and its severity, and to document patterns of OUD-relevant information within clinical notes of heterogeneous patient cohorts. We developed an annotation schema to characterize OUD severity based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. In total, 2 annotators reviewed clinical notes from key encounters of 100 adult patients with varied evidence of OUD, including patients with and those without chronic pain, with and without medication treatment for OUD, and a control group. We completed annotations at the sentence level. We calculated severity scores based on annotation of note text with 18 classes aligned with criteria for OUD severity and determined positive predictive values for OUD severity. The annotation schema contained 27 classes. We annotated 1436 sentences from 82 patients; notes of 18 patients (11 of whom were controls) contained no relevant information. Interannotator agreement was above 70% for 11 of 15 batches of reviewed notes. Severity scores for control group patients were all 0. Among noncontrol patients, the mean severity score was 5.1 (SD 3.2), indicating moderate OUD, and the positive predictive value for detecting moderate or severe OUD was 0.71. Progress notes and notes from emergency department and outpatient settings contained the most and greatest diversity of information. Substance misuse and psychiatric classes were most prevalent and highly correlated across note types with high co-occurrence across patients. Implementation of the annotation schema demonstrated strong potential for inferring OUD severity based on key information in a small set of clinical notes and highlighting where such information is documented. These advancements will facilitate NLP tool development to improve OUD prevention, diagnosis, and treatment.

Adverse Childhood Experiences and Opioid Use Disorder: A Systematic Review

Over the past several decades, opioid use has consistently increased. Thought to be related to poor prescribing and drug availability, since the onset of the pandemic, there has been a dramatic shift in opioid overdoses. While pandemic stress may explain some of the rapid rise in drug misuse, research suggests other variables (i.e., trauma) may make individuals particularly vulnerable to opioid use and abuse. This systematic review sought to examine the relationship between adverse childhood experiences (ACEs) and opioid use disorder (OUD). Following guidelines established by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), we conducted this systematic review using the Pubmed academic database. Searching research beginning in 2000-current, we found 48 articles that met our inclusion criteria. We used a team-based approach to conduct a thematic synthesis of the data. Four central analytical themes emerged including the nature of childhood relationship patterns, type of ACE, ACEs and OUD moderators, and biomarkers as predictors of OUDs. Several findings from this review may help to explain the relationship between ACEs and OUD. OUD is partially predicted by ACEs severity and frequency, type of ACE (i.e., abuse, neglect, parental substance use), psychiatric comorbidities, neurotransmitter level, and genetics. Resiliency may be key to OUD prevention. Both ACEs and OUD make lasting alterations in brain structure and biochemical pathways. Future research should focus on treatments to disrupt biochemical pathways that solidify craving. Clinicians may help by using risk-based assessments, promoting resiliency, and including families in treatment.

Opioid prescriber screening practices to detect risk for developing opioid use disorder: Qualitative perspectives from providers during the fourth wave of the opioid crisis

Little is known about how clinical providers assess risk for opioid use disorder (OUD), especially when considering prescriptions for opioid-naïve patients with acute pain. While formal screening tools exist, they are not widely used, and may not be sensitive enough to identify low-risk individuals who are susceptible to developing an OUD. Therefore, we sought to understand opioid prescribers' perspectives on their screening practices. We conducted qualitative interviews with 32 opioid prescribers across Massachusetts (11/2020–08/2021); approximately half (47%) used screening tools to identify risk for developing an OUD. We inquired about providers' risk-related screening practices before prescribing opioids, management of high-risk patients, and perspectives on barriers and facilitators to effective screening. We used a deductive content analytic approach, examining the results through a stratified lens based on use of screening methods. General prescribing and risk assessment practices did not vary by strata; however, perspectives on screening were different, as were challenges and barriers that providers identified. Recommendations from those who utilized screeners focused on standardizing and streamlining screening processes; those who did not screen suggested making risk assessments clear to avoid interpretation issues and limiting biases toward certain population groups. Findings are framed in the context of the Normalization Process Theory, addressing a lack of coherence in providers’ understanding of screeners and lack of cognitive participation and collective action across their practices surrounding OUD screening. Future research with providers should focus on strategies to integrate effective procedures around OUD prevention into their practices and methods to evaluate their impact.

Structure-Based Design of Glycosylated Oxytocin Analogues with Improved Selectivity and Antinociceptive Activity.

Acute and chronic pain is often treated with opioids despite the negative side effects of constipation, physical dependence, respiratory depression, and overdose. The misuse of opioid analgesics has given rise to the opioid crisis/epidemic, and alternate nonaddictive analgesics are urgently needed. Oxytocin, a pituitary hormone, is an alternative to the small molecule treatments available and has been used as an analgesic as well as for the treatment and prevention of opioid use disorder (OUD). Clinical implementation is limited by its poor pharmacokinetic profile, a result of the labile disulfide bond between two cysteine residues in the native sequence. Stable brain penetrant oxytocin analogues have been synthesized by replacement of the disulfide bond with a stable lactam and glycosidation of the C-terminus. These analogues show exquisite selectivity for the oxytocin receptor and potent in vivo antinociception in mice following peripheral (i.v.) administration, supporting further study of their clinical potential.

Quality of Life and Opioid Use Motives: Direct and Indirect Associations with Risky Opioid Use in a Community Sample of Adults

Purpose: The opioid epidemic in the United States has resulted in mass mortality and economic costs exceeding $1 trillion. Poor health-related quality of life is evident among individuals entering treatment for opioid use disorder (OUD). Yet, little research has examined the influence of quality of life on risky opioid use among non-treatment-seeking adults. To help inform OUD prevention efforts, this study examined the association among quality of life domains, opioid use motives, and risky opioid behaviors in a community sample of opioid users. Methods: Participants (N = 278) were adults who endorsed past month opioid use and were not currently in treatment for OUD. Participants responded to questions regarding their opioid use and misuse, opioid use motives, opioid use consequences, and quality of life. Results: The physical health domain of quality of life was associated with risky opioid use. Specifically, poorer physical health predicted risky opioid use and this relationship was partially explained by more social and pain motives to use opioids. Surprisingly, no other quality of life domains predicted risky opioid use. Conclusion: This study represents a meaningful first step in identifying optimal targets for OUD prevention efforts with community samples. Our findings suggest that physical health is an important quality of life indicator to prevent opioid-related harm and development of OUD.

Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it's time to act now.

The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis.

Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers’ capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.

National Trends in Suicide Thoughts and Behavior among US Adults with Opioid Use Disorder from 2015 to 2020

Introduction Suicide thoughts and behavior (STB) are associated with premature mortality and is disproportionately represented among those with opioid use disorder (OUD). Recent trends in STB among those with OUD are lacking. We investigated trends in STB among US adults with versus without OUD using six waves of cross-sectional, nationally-representative, epidemiological data. Methods Data came from the 2015–2020 National Survey on Drug Use and Health (combined n = 241,675). We compared past-year STB outcomes (i.e., thoughts of seriously considering killing self (SI), suicide plan (SP), suicide attempt (SA)) among adults with versus without past-year OUD. Unadjusted and adjusted logistic regression tested the association between survey-year and past-year STB outcomes (i.e., SI, SP/SA) stratified by OUD status. Results Between 2015 and 2020, 26% versus 4% of those with and without OUD, respectively, reported SI, 10% versus 1% reported a SP, and 6% versus 1% reported SA (all ps < 0.001). In adjusted analyses, across survey years, no changes in the prevalence of SI were observed for adults with or without OUD, and no changes were observed over time for SP/SA in adults with or without OUD. OUD severity and treatment status did not moderate the relationship between OUD and STB outcomes. Conclusions Among US adults, OUD was associated with thoughts of suicide and suicide behavior. The heightened prevalence of STB in adults with OUD has not changed in recent years. Screening for SI is needed among those reporting opioid misuse and should be routinely integrated into OUD prevention and treatment.

Reducing Emergency Department Visits and Opioid-Related Deaths in Maryland

The state of Maryland has consistently ranked among the top states by opioid-involved overdose deaths. Emergency rooms in Maryland have been overrun with patients struggling with opioid use disorder (OUD). While hospitals are heavily burdened, it has become clear that they serve as a critical entry point for OUD prevention programs. Despite this, when section 19-310 of the Maryland Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 passed, it included vague language requiring hospitals to create their own discharge protocols for such patients rather than putting into place statewide mandates. We propose two alternative solutions. First, the Maryland General Assembly can amend the HOPE and Treatment Act of 2017 to mandate that peer recovery services be made available during inpatient care, within the emergency department, and post-discharge for patients presenting with OUD. Second, we recommend the addition of a subtitle to describe how to establish and operate mobile clinic treatment programs. The former amendment would offer a prompt solution that could reduce opioid-related hospitalizations and deaths in the state. It will also help reach underrepresented populations who are the least likely to access peer recovery support and other health services in response to OUD.

Perspectives on opioid misuse from public service psychology: An introduction.

Despite practicing in multiple venues where people with opioid use disorders require services, most public service psychology providers are not delivering, or being trained to deliver, treatment for substance use disorders. In addition, unintentional overdose and death from opioids continue, treatment options for chronic pain remain limited, and a larger discussion on the problem and role of drug and alcohol addiction in society remains largely unspoken. The articles received and included in this special section present some changes in the way that precipitants and prevention of opioid use disorder may be addressed and the role of psychologists in this work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emergency Nurse Perceptions of Pain and Opioids in the Emergency Department

The opioid crisis is a national health emergency with immense morbidity, mortality, and socioeconomic cost. Emergency department (ED) pain management is tightly linked to the issue of opioid use disorder (OUD), because opioid exposure is necessary for development of OUD. Emergency nurses are on the frontlines of this complex problem, yet little, if any, attention has been paid to the role they play in the prevention and management of either pain or OUD in this unique and important setting. A framework that conceptualizes and optimizes emergency nurses as change agents in the opioid epidemic is urgently needed. While ED pain management and OUD prevention is dependent on the entire care team, this innovative study qualitatively characterizes emergency nurse perceptions of pain management, OUD prevention, and their potential role in each. Content analysis produced 14 categories that were clustered into two themes, “nurses influence ED pain management” and “adjustments in ED pain management”, and an overarching message that “pain management depends on the care team.” By generating a more comprehensive and nuanced understanding of the role played by emergency nurses, our findings provide essential insights into potential interventions and frameworks.

Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions.

Improving HIV and Hepatitis C Virus (HCV) management among people involved in the criminal justice (CJ) system who use drugs, in particular those with opioid use disorder (OUD), requires effective approaches to screening, linkage, and adherence tointegrated prevention and treatment services across correctional and community agencies and providers. This manuscript reviews the literature to explore gaps in HIV, Hepatitis C, and OUD prevention, treatment, and delivery cascades of care for persons involved in the CJ system. Specifically, we compare two models of linkage to prevention and treatment services: Peer/Patient Navigation (PN) wherein the PN links CJ-involved individuals to community-based infectious disease (ID) and substance use prevention and treatment services, and Mobile Health Units (MHU) wherein individuals are linked to a MHU within their community that provides integrated ID and substance use prevention and treatment services. The most notable finding is a gap in the literature, with few to no comparisons of models linking individuals recently released from the CJ system to integrated HIV, Hepatitis C, and OUD prevention and treatment and other harm reduction services. Further, few published studies address the geographical distinctions that affect service implementation and their effects on these substance use, ID and harm reduction care cascades. This manuscript makes specific recommendations to fill this gap through a detailed evaluation of PN and MHU linkage models to co-located and integrated HIV, Hepatitis C, and OUD prevention and treatment services across different communities within the U.S.

Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis

ObjectivesThis study describes community pharmacists’ opioid analgesic and medication for opioid use disorder (MOUD) practice behaviors and behavioral intentions in the context of primary, secondary, and tertiary prevention of opioid use disorder (OUD). MethodsThe study sampling frame consisted of 2302 Tennessee community-practice pharmacists who were asked to complete a mailed, paper questionnaire. Behavioral intentions were elicited by asking pharmacists to indicate the number of times (0 to 10) they engage in a behavior, given 10 patients in 3 distinct vignettes. Perceptions of evidence-based MOUD and pain management patient care practices were also elicited. ResultsA response rate of 19.7% was achieved. Pharmacists reported using a brief questionnaire to evaluate risk of opioid misuse with 2.1 ± 3.7 (mean ± SD) out of 10 patients, screening 2.1 ± 3.7 patients for current opioid misuse, discussing co-dispensing of naloxone with 2.9 ± 3.4 to 3.3 ± 4 out of 10 patients at a risk of overdose, and dispensing buprenorphine/naloxone to a mean of 4.6 ± 4.2 patients when they presented a prescription. Respondents perceived 38% of pain management and 30% of MOUD prescribers in their area to practice evidenced-based care. ConclusionPharmacists have an opportunity to improve the outcomes for patients prescribed opioids by increasing engagement across OUD prevention levels.

Urban-Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross-Sectional Analysis.

Urban and rural areas have been differentially impacted by opioid use disorder (OUD) and related adverse outcomes, yet little systematic study of the urban-rural divide in OUD prevention and response activities exists. This study compares policy and programmatic activities to tackle the opioid crisis in metropolitan versus nonmetropolitan areas, and within their subclassifications. All county governments in 5 purposively selected states were surveyed. Metropolitan and nonmetropolitan counties, and their subclassifications, were compared in their reported implementation of 19 opioid policy and programmatic activities, using 2-sample proportion and 1-way analysis of variance (ANOVA) tests with Bonferroni-corrected multiple comparisons. Of the 358 counties surveyed, 171 (response rate = 48%) responses were obtained. The implementation rate of nonmetropolitan counties was lower than that of metropolitan counties for all activities, although not all differences were statistically significant. Within nonmetropolitan areas, the implementation rate of noncore counties was lower than that of micropolitan counties for all activities, and statistically significant differences were found for providing treatment and rehabilitation facilities, allowing arrest alternatives for opioid offenses, and providing opioid detection and treatment training to first responders, among other activities. The results of this study corroborate claims that nonmetropolitan areas, and particularly noncore areas, face greater barriers to implementing opioid policy and programmatic activities. This study identifies activity areas where rural counties are especially lacking and federal and state governments could support efforts for bending the curve of the opioid crisis.

Change in opioid policies in New England emergency departments, 2014 vs 2018

ObjectiveThe U.S. opioid epidemic persists, yet it is unclear if opioid-related emergency department (ED) policies have changed. We investigated: 1) the prevalence of opioid use disorder (OUD) prevention and treatment policies in New England EDs in 2018, and 2) how these policies have changed since 2014. MethodsUsing the National Emergency Department Inventory-USA, we identified and surveyed all New England EDs in 2015 and 2019 about opioid-related policies in 2014 and 2018, respectively. The surveys assessed OUD prevention policies (to use a screening tool, access the Prescription Drug Monitoring Program [PDMP], notify primary care providers, prescribe/dispense naloxone) and treatment policies (to refer to recovery resources, prescribe/dispense buprenorphine). ResultsOf 194 EDs open in 2018, 167 (86 %) completed the survey. Of 193 EDs open in 2018 and 2014, 147 (76 %) completed both surveys. In 2018, the most commonly-reported policy was accessing the PDMP (96 %); the least commonly-reported policy was prescribing/dispensing buprenorphine to at risk patients (37 %). EDs varied in prescribing/dispensing naloxone: 35 % of EDs offered naloxone to ≥80 % of patients at risk of opioid overdose versus 33 % of EDs to <10 % of patients at risk. Most EDs (74 %) reported prescribing/dispensing buprenorphine to <10 % of patients with OUD. Comparing 2018 to 2014, the greatest difference in policy use was in prescribing/dispensing naloxone (+55 %, p < 0.001). ConclusionImplementation of opioid-related ED policies increased between 2014 and 2018. Continued effort is needed to understand the extent to which policy implementation translates to clinical care, and to best translate evidence-based policies into clinical practice.

Non-invasive brain stimulation modalities for the treatment and prevention of opioid use disorder: a systematic review of the literature

The U.S. is currently facing an unprecedented epidemic of opioid-related deaths. Despite the efficacy of the current treatments for opioid use disorder (OUD), including psychosocial interventions and medication-assisted therapy (MAT), many patients remain treatment-resistant and at high risk for overdose. A potential augmentation strategy includes the use of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and auricular vagus nerve stimulation (aVNS). These approaches may have therapeutic benefits by directly or indirectly modulating the neurocircuitry affected in OUD. In this review, we evaluate the available studies on NIBS in the context of OUD withdrawal and detoxification, maintenance, and cravings, while also considering analgesia and safety concerns. In the context of opioid withdrawal and detoxification, a percutaneous form of aVNS has positive results in open-label trials, but has not yet been tested against sham. No randomized studies have reported on the safety and efficacy of NIBS specifically for maintenance treatment in OUD. TMS and tDCS have demonstrated effects on cravings, although published studies were limited by small sample sizes. NIBS may play a role in reducing exposure to opioids and the risk of developing OUD, as demonstrated by studies using tDCS in an experimental pain condition and TMS in a post-operative setting. Overall, while the preliminary evidence and safety for NIBS in the prevention and treatment of OUD appears promising, further research is needed with larger sample sizes, placebo control, and objective biomarkers as outcome measures before strong conclusions can be drawn.

Children and families of the opioid epidemic: Under the radar

As increasing resources are now being directed towards addressing the growing U.S. opioid epidemic, the long-term care of children from opioid-affected families has been relatively neglected. While an array of evidence suggests long-term negative developmental, medical, and social impacts to children related to their parents' opioid use, there remains much to be learned about how best to support children and families to promote healthy outcomes. Here, we report on the launch of an innovative family-centered pediatric medical home for opioid-affected families in Boston. We describe the program, the patient cohort, and early lessons learned. Important themes include the vulnerability of families with infants whose parents are in early recovery, and the need for compassionate, high-touch, high-continuity, team-based care that views the needs of the family as a whole. We recommend a future emphasis on non-stigmatizing, trauma-informed care; centering the needs of the family by addressing social and logistics barriers and by expanding models of parent-child dyadic care; investing in attachment and mental health interventions; developing strategies for prevention of opioid use disorder (OUD) in the next generation; and grounding our advocacy and actions in a social justice approach.

Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017-2018.

In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. These standards prescribe three levels of hospital and emergency department treatment and prevention of opioid use disorder and opioid overdose and mechanisms for referral to treatment and epidemiological surveillance. By June 2018, all Rhode Island licensed acute care facilities had implemented policies meeting the standards' requirements. This policy has standardized care for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder.

The Opioid Epidemic in Africa And Its Impact.

Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed. A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD. OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management, and infectious disease transmission reduction.